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Background Individual studies have demonstrated the potential of diffusion-weighted magnetic resonance imaging (DWI-MRI) for identifying inflamed bowel segments. However, these studies were conducted with rather small patient cohorts and in most cases by means of MR enterography only. Purpose To demonstrate the feasibility of detecting inflamed bowel segments in a large collective of patients with Crohn's disease using DWI in MR enteroclysis and MR enterography and to compare the results of both techniques, also considering clinical parameters by means of the Harvey-Bradshaw Index (HBI). Material and Methods Ninety-six patients underwent MRI enteroclysis and 35 patients MR enterography, both with additional DWI. The HBI as well as apparent diffusion coefficients (ADC) in areas of inflamed and normal bowel wall were determined. Thus resulting in 208 bowel segments that were visualized and subsequently statistically analyzed. Results There were no significant differences in ADC values in MR enteroclysis and MR enterography ( P = 0.383 in inflammation, P = 0.223 in normal wall). Areas of inflammation showed statistically highly significant lower ADC values than areas of normal bowel wall ( P < 0.001). An ADC threshold of 1.56 × 10-3 mm2/s can distinguish between normal and inflamed bowel segments with a sensitivity of 97.4% and a specificity of 99.2%. A highly significant correlation could be shown between ADC and HBI values ( P = 0.001). Conclusion DWI-MRI facilitates recognition of inflamed bowel segments in patients with Crohn's disease and the ADC values show an excellent correlation to the HBI. There were no significant differences in ADC values in MR enteroclysis and MR enterography. An ADC threshold of 1.56 × 10-3 mm2/s differentiates between normal and inflamed bowel wall.
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Doença de Crohn/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Inflamação/diagnóstico por imagem , Intestinos/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Doença de Crohn/complicações , Estudos de Viabilidade , Feminino , Humanos , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto JovemRESUMO
Background Different methods for bowel distension prior to magnetic resonance imaging (MRI) examinations were described in recent years. Purpose To compare orally administered psyllium or locust bean gum / mannitol (LBM) with tylose administered through a duodenal catheter for bowel distension in patients undergoing MRI examination of the small bowel. Material and Methods Three different methods of bowel distension prior to MRI were compared: tylose applied through a duodenal catheter and orally administered psyllium and LBM in three groups with 15 patients each. Datasets were blinded and reviewed independently by two experienced radiologists, who assessed the diagnostic value and the maximum luminal diameter. Results Tylose was superior to psyllium and LBM in the examination of the duodenum and proximal jejunum. LBM was superior to the other methods for distension of the ileum and terminal ileum. The greatest luminal diameter of the duodenum was achieved after tylose and distension of the terminal ileum was the best in patients receiving LBM. The psyllium group was inferior to the other two groups in all segments. Conclusion By using LBM as an oral method of bowel distension, many patients can avoid the unpleasant placement of a duodenal catheter without compromising the diagnostic value of the examination.
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Galactanos/farmacologia , Intestino Delgado/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Mananas/farmacologia , Manitol/farmacologia , Metilcelulose/análogos & derivados , Gomas Vegetais/farmacologia , Psyllium/farmacologia , Adolescente , Adulto , Idoso , Criança , Duodeno , Feminino , Humanos , Masculino , Metilcelulose/farmacologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Gastroenteropancreatic neuroendocrine neoplasia (GEP-NEN) is a heterogeneous and complex group of tumors that are often difficult to classify due to their heterogeneity and varying locations. As standard radiological methods, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET/CT) are available for both localization and staging of NEN. Nuclear medical imaging methods with somatostatin analogs are of great importance since radioactively labeled receptor ligands make tumors visible with high sensitivity. CT and MRI have high detection rates for GEP-NEN and have been further improved by developments such as diffusion-weighted imaging. However, nuclear medical imaging methods are superior in detection, especially in gastrointestinal NEN. It is important for radiologists to be familiar with NEN, as it can occur ubiquitously in the abdomen and should be identified as such. Since GEP-NEN is predominantly hypervascularized, a biphasic examination technique is mandatory for contrast-enhanced cross-sectional imaging. PET/CT with somatostatin analogs should be used as the subsequent method.
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BACKGROUND: MR-enterography/enteroclysis (MRE) is increasingly used for primary diagnosis, detection of complications, and monitoring of patients with inflammatory bowel disease (IBD). Standardization of reporting is relevant to ensure quality of the methodology and to improve communication between different faculties. The current manuscript describes the features that are required for optimized reporting of MRE in IBD. METHODS: An expert consensus panel of radiologists and gastroenterologists conducted a systematic search of the literature. In a Delphi process, members of the German Radiological Society (DRG) and members of the Competence Network for Inflammatory Bowel Diseases voted on relevant criteria for the reporting of findings in MRE. Based on the voting results, statements were developed by the expert consensus panel. RESULTS: Clinically relevant aspects of MRE findings have been defined to optimize reporting and to standardize terminology. Minimal requirements for standardized reporting are suggested. The statements focus on the description of disease activity as well as on complications of IBD. Attributes of intestinal inflammation are described and illustrated by exemplary images. CONCLUSION: The current manuscript provides standardized parameters and gives practical recommendations on how to report and how to characterize MRE findings in patients with IBD. KEY POINTS: · Systematic overview provides practice-oriented recommendations and names and evaluates the decisive criteria for reporting and interpretation of MRI in inflammatory bowel disease.. · Standardized terminology and reporting criteria for MRI in IBD improves interdisciplinary communication.. · Standardized collection and documentation of MRI findings in IBD helps to further establish the method and to improve care for IBD patients.. CITATION FORMAT: · Wessling J, Kucharzik T, Bettenworth D etâal. Intestinal MRI in Inflammatory Bowel Disease - Literature and Survey-Based Recommendations regarding Reporting by the German Radiological Society (DRG) and the German Competence Network for Inflammatory Bowel Diseases. Fortschr Röntgenstr 2023; 195: 675â-â690.
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Doenças Inflamatórias Intestinais , Humanos , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Intestinos , Imageamento por Ressonância Magnética/métodos , Radiografia , Guias de Prática Clínica como AssuntoRESUMO
Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) ≥ 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology.
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BACKGROUND: During the extremely challenging 4,487 km ultramarathon TransEurope-FootRace 2009, runners showed considerable reduction of body weight. The effects of this endurance run on brain volume changes but also possible formation of brain edema or new lesions were explored by repeated magnetic resonance imaging (MRI) studies. METHODS: A total of 15 runners signed an informed consent to participate in this study of planned brain scans before, twice during, and about 8 months after the race. Because of dropouts, global gray matter volume analysis could only be performed in ten runners covering three timepoints, and in seven runners who also had a follow-up scan. Scanning was performed on three identical 1.5 T Siemens MAGNETOM Avanto scanners, two of them located at our university. The third MRI scanner with identical sequence parameters was a mobile MRI unit escorting the runners. Volumetric 3D datasets were acquired using a magnetization prepared rapid acquisition gradient echo (MPRAGE) sequence. Additionally, diffusion-weighted (DWI) and fluid attenuated inversion recovery (FLAIR) imaging was performed. RESULTS: Average global gray matter volume as well as body weight significantly decreased by 6% during the race. After 8 months, gray matter volume returned to baseline as well as body weight. No new brain lesions were detected by DWI or FLAIR imaging. CONCLUSIONS: Physiological brain volume reduction during aging is less than 0.2% per year. Therefore a volume reduction of about 6% during the 2 months of extreme running appears to be substantial. The reconstitution in global volume measures after 8 months shows the process to be reversible. As possible mechanisms we discuss loss of protein, hypercortisolism and hyponatremia to account for both substantiality and reversibility of gray matter volume reductions. Reversible brain volume reduction during an ultramarathon suggests that extreme running might serve as a model to investigate possible mechanisms of transient brain volume changes. However, despite massive metabolic load, we found no new lesions in trained athletes participating in a multistage ultramarathon.See related commentary http://www.biomedcentral.com/1741-7015/10/171.
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Encéfalo/anatomia & histologia , Corrida , Adulto , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos ProspectivosRESUMO
PURPOSE: To analyze the impact of the COVID-19 pandemic in 2020 on the radiological imaging volume in Germany. MATERIALS UND METHODS: In this retrospective multicenter study, we analyzed CT and MRI examinations of 7 radiology institutes across Germany from January to December 2020. The imaging volume was compared to 2019 (Wilcoxon-Mann-Whitney test). Modality, patient service locations, and examined body parts were assessed in consideration of time periods of the pandemic. In addition, correlation with the incidence of SARS-CoV-2 cases and associated death was performed (Spearman-test). RESULTS: In total, in 2020, imaging volume declined by 4â% (nâ=â8314) compared with 2019 (pâ<â0.05). The hard lockdown during the first pandemic wave (calendar week 12-16, March 22 - April 19) revealed the highest decrease with 29â% (nâ=â894, pâ<â0.01), with the greatest decrease in CT (36â% vs. MRI 26â%), outpatients (38â%, pâ<â0.01), and imaging of the spine and extremities (51-72â%, <â0.05 - pâ<â0.01). Examinations referred from the emergency department (-13â%, pâ<â0.05) and CT of the chest (-16â%, pâ<â0.05) were least affected. With the end of the first wave, gradual normalization of the imaging volume was observed and persisted until the end of the observation period. A reduction of imaging volume negatively correlated with the incidence of SARS-CoV-2-positive cases and associated deaths (râ=â0.28 and 0.49, pâ<â0.05 and pâ<â0.001). CONCLUSION: The COVID-19 pandemic was associated with a significant temporary decline in imaging volume. After the first lockdown period, a quick recovery was observed with radiologic imaging examinations steadily approaching prior-year figures. KEY POINTS: · This study assesses the impact of dynamic pandemic activity on radiological imaging in a multicenter analysis in Germany.. · The COVID-19 pandemic was associated with a temporary decline in CT and MRI scans.. · Relaxation of restrictions was associated with fast normalization of imaging volumes to prior-year levels, which persisted until the end of the year.. · Significant catch-up effects were not observed.. CITATION FORMAT: · Schmidbauer M, Grenacher L, Juchems MS etâal. Impact of the COVID 19 Pandemic on Radiological Imaging in Germany. Fortschr Röntgenstr 2022; 194: 625â-â633.
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COVID-19 , Radiologia , Controle de Doenças Transmissíveis , Alemanha/epidemiologia , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2RESUMO
The Atlanta classification published in 1992 was supposed to classify the severity and complications in acute pancreatitis with the goal of providing uniform terminology for clinicians and researchers. After continuous evolution, the revised Atlanta classification was published in 2012. In this updated classification, imaging aspects were better integrated and unclear terms were better defined. To date, this terminology for disease grading, severity, and local complications has been solely available in English. This prevented wide acceptance of the classification by the German-speaking medical community. Therefore, an expert team of the German Radiological Society translated the terms based on German medical literature. This translation was approved by consensus in the new S3 guideline meeting in February 2020 with an approval rate of 97.3â%. This manuscript explains the translated and approved German terminology of the revised Atlanta classification and offers additional imaging examples. KEY POINTS:: · The revised Atlanta classification allows correct definition of the grading and complication assessment of acute pancreatitis.. · An expert group translated the terms into the German language. The translation was approved by the S3 guideline committee for pancreatitis.. · Based on the new German S3 guideline for pancreatitis, the translated terms should be employed consistently.. CITATION FORMAT: · Schreyer AG, Seidensticker M, Mayerle J etâal. German Terminology of the Revised Atlanta Classification of Acute Pancreatitis: Glossary Based on the New German S3 Guideline on Acute, Chronic, and Autoimmune Pancreatitis. Fortschr Röntgenstr 2021; 193: 909â-â918.
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Pancreatite Autoimune , Pancreatite , Doença Aguda , Diagnóstico por Imagem , Humanos , Idioma , Pancreatite/diagnóstico por imagem , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Radiological reports of pancreatic lesions are currently widely formulated as free texts. However, for optimal characterization, staging and operation planning, a wide range of information is required but is sometimes not captured comprehensively. Structured reporting offers the potential for improvement in terms of completeness, reproducibility and clarity of interdisciplinary communication. METHOD: Interdisciplinary consensus finding of structured report templates for solid and cystic pancreatic tumors in computed tomography (CT) and magnetic resonance imaging (MRI) with representatives of the German Society of Radiology (DRG), German Society for General and Visceral Surgery (DGAV), working group Oncological Imaging (ABO) of the German Cancer Society (DKG) and other radiologists, oncologists and surgeons. RESULTS: Among experts in the field of pancreatic imaging, oncology and pancreatic surgery, as well as in a public online survey, structured report templates were developed by consensus. These templates are available on the DRG homepage under www.befundung.drg.de and will be regularly revised to the current state of scientific knowledge by the participating specialist societies and responsible working groups. CONCLUSION: This article presents structured report templates for solid and cystic pancreatic tumors to improve clinical staging (cTNM, ycTNM) in everyday radiology. KEY POINTS: · Structured report templates offer the potential of optimized radiological reporting with regard to completeness, reproducibility and differential diagnosis.. · This article presents consensus-based, structured reports for solid and cystic pancreatic lesions in CT and MRI.. · These structured reports are available open source on the homepage of the German Society of Radiology (DRG) under www.befundung.drg.de.. CITATION FORMAT: · Persigehl T, Baumhauer M, Baeßler B etâal. Structured Reporting of Solid and Cystic Pancreatic Lesions in CT and MRI: Consensus-Based Structured Report Templates of the German Society of Radiology (DRG). Fortschr Röntgenstr 2020; 192: 641â-â655.
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Imageamento por Ressonância Magnética/métodos , Cisto Pancreático/diagnóstico por imagem , Pancreatopatias/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Sistemas de Informação em Radiologia , Projetos de Pesquisa , Tomografia Computadorizada por Raios X/métodos , Alemanha , Humanos , Radiologia , Sociedades MédicasRESUMO
The purpose of this study was to determine the prevalence and characteristics of the cisterna chyli (CC) in a large 3,000-patient cohort and to identify potential predisposing factors for the development of a CC. Three thousand consecutive contrast-enhanced CT examinations (1,261 women, 1,739 men, mean age 61.0 years) of the chest and/or abdomen were included in this retrospective study. Imaging characteristics of the CC (size, attenuation, location) were documented as well as clinical information (malignant disease, pattern of metastasis). A CC was found in 16.1% of the patients with an average volume of 302 microl. The mean attenuation was 4.8 Hounsfield units (HU). Twenty percent of the CC showed CT densities of 15 HU and higher. Patients with malignancies showed a significantly (p < 0.001) higher prevalence of CC (340/1,757, 19.4%) than patients with benign conditions (144/1,243, 11.6%). Especially the finding of a large CC (>1,000 microl) represents an elevated relative risk for malignancy of 1.7 (p = 0.0017). We found a significant association between malignant disease and the presence and size of a cisterna chyli. Identifying the continuity between the CC and the thoracic duct is a safer method to distinguish a CC from retrocrural lymph nodes than near-water CT attenuation alone.
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Metástase Linfática/diagnóstico por imagem , Medição de Risco/métodos , Ducto Torácico/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: As diffusion-weighted imaging is increasingly implemented into routine protocols of abdominal MRI, abnormal findings in expected and unexpected locations become more common. The aim of our retrospective study was to investigate the specificity of restricted diffusion in differentiation of benign from malignant abdominal disease. MATERIALS AND METHODS: Two hundred thirty consecutively registered patients underwent abdominal MRI including diffusion-weighted imaging (single-shot spin-echo echo-planar sequence) with b values of 0, 150, 500, and 1,000 s/mm(2). Lesions were detected by two blinded readers using only the images with a b value of 1,000 s/mm(2), and representative apparent diffusion coefficients were measured. Lymph nodes were not documented. RESULTS: Fifty-two of the 230 patients had a total of 55 lesions with restricted diffusion (23.9%). The mean apparent diffusion coefficient was 809 mm(2)/s. Forty-three lesions (78.2%) were malignant. The 12 benign lesions were liver hemangioma, liver adenoma, autoimmune pancreatitis, pancreatic teratoma, two abscesses, three cases of inflammatory bowel wall thickening due to Crohn's disease, Bartholin cyst, hemorrhagic ovarian cyst, and renal Rosai-Dorfman disease. CONCLUSION: Restricted diffusion is generally considered to be associated with malignant tumors because of the high cellularity of these tumors. However, in interpretation of diffusion-weighted images, it should be kept in mind that a number of benign lesions, as many as 22% in our cohort, can exhibit restricted diffusion on images with high b values, thus mimicking malignant lesions.
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Neoplasias Abdominais/diagnóstico , Artefatos , Imagem de Difusão por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Água Corporal/metabolismo , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
BACKGROUND: The purpose of this study was to evaluate whether an electronic-colonic-cleansing (ECC) algorithm is beneficial for the diagnostic performance compared to a CT colonography (CTC) evaluation without electronic cleansing in tagged datasets. METHODS: Two blinded readers evaluated CTC datasets from 79 patients with 153 colorectal polyps confirmed by optical colonoscopy. Cases were read in a randomized order with and without the use of electronic colon-cleansing software. Per-polyp sensitivity, per-polyp/per-patient specificity and reading times (with and without ECC) have been calculated and reported. RESULTS: Per-polyp sensitivity for polyps >6 mm without using ECC was 60.4% (Reader 1: 59.7%, Reader 2: 61.1%), while polyps >10 mm were detected with a sensitivity of 58.3% (Reader 1: 66.7%, Reader 2: 50%). On electronically cleansed datasets, the sensitivity was 73.6% (Reader 1: 76.4%; Reader 2: 70.8%) for polyps >6 mm and 83.3% (Reader 1: 83.3%; Reader 2: 83.3%), respectively. Per-patient specificity was 75% without using cleansing (Reader 1: 68%, Reader 2: 82%) and 81.5% using ECC (Reader 1: 86%, Reader 2: 77%). CONCLUSION: Reading CTC cases using ECC software improves sensitivity in detecting clinically relevant colorectal polyps.
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Algoritmos , Colonografia Tomográfica Computadorizada/métodos , Processamento de Imagem Assistida por Computador/métodos , Intensificação de Imagem Radiográfica/métodos , Técnica de Subtração/estatística & dados numéricos , Bário , Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colo/diagnóstico por imagem , Pólipos do Colo/diagnóstico por imagem , Meios de Contraste , Diatrizoato , Diatrizoato de Meglumina , Humanos , Imageamento Tridimensional/métodos , Variações Dependentes do Observador , Fosfatos/administração & dosagem , Sensibilidade e Especificidade , Fatores de TempoAssuntos
Meios de Contraste , Neoplasias Hepáticas , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Alemanha , Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Radiologia/normas , Fígado/diagnóstico por imagem , Fígado/patologia , Sociedades MédicasRESUMO
BACKGROUND: Strongyloidiasis is a rare helminthic infection in Europe, and it may cause duodenal obstruction. METHODS: We report a patient who was admitted to our Medical Department with nausea and repeated vomiting since 10 years until food intake became impossible. Subsequent investigations revealed a duodenal obstruction at the upper third of the duodenum, as well as enterocolitis of the terminal ileum with eosinophils dispersed throughout the mucosa. Since food intake was still not possible after treatment with a course of i.v. PPI and prokinetic applications, we decided to perform a resection of the upper duodenum with Y-Roux reconstruction. RESULTS: The histopathological examination of the resected specimen revealed strongyloidiasis. CONCLUSION: Parasite infections such as strongyloidiasis represent a rare differential diagnosis of duodenal obstruction especially if patients originate from endemic regions.
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Obstrução Duodenal/parasitologia , Strongyloides stercoralis , Estrongiloidíase/complicações , Animais , Antiparasitários/administração & dosagem , Constrição Patológica , Dilatação Patológica , Duodeno/parasitologia , Duodeno/patologia , Endoscopia Gastrointestinal , Endossonografia , Humanos , Ivermectina/administração & dosagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Náusea/parasitologia , Estômago/patologia , Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Vômito/parasitologiaRESUMO
OBJECTIVE: The purpose of this study was to analyze the pulmonary vessel enhancement obtainable using high-density contrast material and saline flushing with automated bolus tracking for multidetector-row computed tomographic (MDCT) pulmonary angiography in a routine clinical setting. METHODS: Attenuation values of pulmonary vessels were retrospectively measured in 51 CT scans performed on a 40-channel MDCT for unselected emergency patients with clinically suspected pulmonary embolism. RESULTS: Mean vascular attenuation measured 326.7 +/- 104 Hounsfield units (HU) in the pulmonary trunk and 299.1 +/- 102 HU in the left distal lower lobe artery. Mean vascular attenuation values in the distal lower lobe artery were equal or higher than 150 HU for 94.1% (48/51) of patients. CONCLUSIONS: In conclusion, the combination of high-density contrast media and saline flushing with automated bolus tracking on a fast CT scanner reliably results in a homogenously high attenuation of pulmonary vessels, allowing precise delineation of clots down to the subsegmental level in MDCT pulmonary angiography.
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Angiografia/métodos , Iopamidol/análogos & derivados , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVE: Comparison of cleansing effects and colonic distension observed with two polyethyleneglycol-solution (PEG) containing bowel preparation techniques prior to CT-colonography (CTC). MATERIALS AND METHODS: One hundred and three patients that received CTC in our institution were retrospectively evaluated. Fifty-one patients received preparation 1 (BP1; based on a GoLytely formulation+bisacodyl), 52 preparation 2 (BP2; based on a NuLytely formulation+bisacodyl). On multi-planar-reformatted (MPR) images, fluid residuals and colon distension were assessed in five colonic segments, from the ascending colon to the rectum. RESULTS: On average, significantly (p<0.001) lower fluid residuals were assesses when using BP2 regardless of the patient position. In prone position, a significantly lower fluid level was observed in the sigmoid using bowel preparation 2. The average maximum diameter measured for the whole colon was 5.2+/-0.6 cm in prone position and 4.8+/-0.6 cm in the supine position in BP1 (p<0.01). In BP2 the average maximum diameter measured for the whole colon was 5.3+/-0.6 cm in prone position and 4.7+/-0.5 cm in supine position, respectively (p<0.001). CONCLUSION: Overall, lower fluid residuals were scored using BP2. In both preparation groups we achieved better colonic distension in prone position. We were not able to distend the sigmoid better when insufflating air during patient repositioning.
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Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colonografia Tomográfica Computadorizada , Eletrólitos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Tensoativos/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Decúbito Ventral , Estudos Retrospectivos , Soluções , Estatísticas não Paramétricas , Decúbito DorsalRESUMO
AIM: To compare different multidetector computed tomography (MDCT) protocols to optimize pancreatic contrast enhancement. METHODS: Forty consecutive patients underwent contrast-enhanced biphasic MDCT (arterial and portal-venous phase) using a 64-slice MDCT. In 20 patients, the scan protocol was adapted from a previously used 40-channel MDCT scanner with arterial phase scanning initiated 11.1 s after a threshold of 150 HU was reached in the descending aorta, using automatic bolus tracking (Protocol 1). The 11.1-s delay was changed to 15 s in the other 20 patients to reflect the shorter scanning times on the 64-channel MDCT compared to the previous 40-channel system (Protocol 2). HU values were measured in the head and tail of the pancreas in the arterial and portal-venous phase. RESULTS: Using an 11.1-s delay, 74.2 HU (head) were measured on average in the arterial phase and 111.2 HU (head) were measured using a 15-s delay (P < 0.0001). For the pancreatic tail, the average attenuation level was 76.73 HU (11.1 s) and 99.89 HU (15 s) respectively (P = 0.0002). HU values were also significantly higher in the portal-venous phase [pancreatic head: 70.5 HU (11.1 s) vs 84.0 HU (15 s) (P = 0.0014); pancreatic tail: 67.45 HU (11.1 s) and 77.18 HU (15 s) using Protocol 2 (P = 0.0071)]. CONCLUSION: Sixty-four MDCT may yield a higher contrast in pancreatic study with (appropriate) optimization of scan delay time.
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PURPOSE: The purpose of this study was to prospectively determine the diagnostic accuracy of diffusion-weighted imaging (DWI) using MRI in the staging of thoracic lymph nodes in patients with lung cancer, and to compare the performance to that of PET/CT. PATIENTS AND METHOD: 20 consecutive patients (pts) with histologically proven lung cancer were included in this study. In all pts FDG-PET/CT was routinely performed to stage lung carcinoma. Additionally, MRI (1.5T) was performed including native T1w, T1w post contrast medium, T2w, and DWI sequences. Regarding the N stage based on the results of the PET/CT there were 5 patients with N0, 3 patients with N1, 5 patients with N2 and 7 patients with N3. Image analysis was performed by two radiologists (R1 and R2), respectively. The reviewers had to chose between 1 (at least one lymph node within a station is malignant) or 0 (no lymph nodes suspicious for malignancy). First the T1 post contrast sequence was analyzed. In a second step the DWI sequence (b=800) was analyzed. Both steps were performed in a blinded fashion. RESULTS: MR imaging with or without DWI only agreed with the results of the PET/CT regarding the N stage in 80% of the patients-15% were understaged and 5% overstaged. There was excellent interobserver agreement; the N-staging result only differed in 1 patient for DWI, resulting in correlation coefficients of 0.98 for DWI and 1.0 for MRI. Compared to PET-CT MRI overstaged one and understaged 4 patients, while DWI overstaged one and understaged 3 patients. This resulted in correlation coefficients of 0.814 (R1 and R2) for MRI and 0.815 (R1) and 0.804 (R2) for DWI. Regarding the ADC values there were no significant differences between ipsilateral hilar (1.03 mm(2)/s ± 0.13), subcarinal (0.96 mm(2)/s±0.24), ipsilateral mediastinal (1.0mm(2)/s ± 0.18), contralateral mediastinal (0.93 mm(2)/s ± 0.23) and supraclavicular (0.9 mm(2)/s ± 0.23) lymph nodes. CONCLUSION: Diffusion-weighted imaging does not show a clear advantage over conventional MR protocols in the N-staging of lung cancer. MRI with or without DWI shows a moderately correlation with PET/CT with a tendency for understaging.
Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Fluordesoxiglucose F18 , Neoplasias Pulmonares/diagnóstico , Tomografia por Emissão de Pósitrons/métodos , Técnica de Subtração , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Integração de SistemasRESUMO
UNLABELLED: The purpose of this study was to investigate the potential correlation between the size of the cisterna chyli (CC) and the tumor size in patients with malignancies on computed tomography (CT). MATERIALS AND METHODS: Out of a 3000 patient cohort 138 patients with histologically confirmed malignant disease, a detectable CC on CT and at least two CT scans within a 6 month period were included in this retrospective study. Out of 525 scans a total of 711 lesion intervals were evaluated. The volume of the CC and all target lesions (up to three per scan) were recorded. The Pearson correlation coefficient for the two parameters of changes in lesion size and CC size was calculated for the whole cohort and for a 33 patient subgroup that included only patients with tumors that showed the closest association with large CC in a previous study. RESULTS: The mean difference in lesion size for all 711 intervals was -1165µl. The mean difference in CC size for all 711 intervals was -46.6µl. The respective Pearson correlation coefficient was .05 with a non-significant p-value of .1823 (subgroup: r=.04, p=.6358). CONCLUSION: No significant correlation between the progression or regression of malignant disease and the size of the cisterna chyli could be found.
Assuntos
Neoplasias/diagnóstico por imagem , Neoplasias/epidemiologia , Ducto Torácico/diagnóstico por imagem , Ducto Torácico/patologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Idoso , Comorbidade , Progressão da Doença , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Estatística como Assunto , Adulto JovemRESUMO
BACKGROUND: Intragastric balloons are used for short term weight loss therapy in obese. It is possible to monitor the ballon with sonography, however this method is sometimes insufficient in obese patients. Therefore MRI seems to be a potential therapy-monitoring option. PURPOSE: In this feasibility report we want to demonstrate the potential use of functional MRI in monitoring gastric filling, patient satiation and gastric emptying in a obese patient who previously received intragastric balloon placement. MATERIAL AND METHODS: We selected one patient (male, 178 cm, 127 kg, BMI = 40,5 kg/m(2)) who recently received a gastric balloon and visualized gastric motility in presence of the gastric balloon before and after food intake. Fast cross-sectional images in one breathhold spin echo or gradient echo sequences were aquired. Real-time gastric motion was performed with cine mode. RESULTS: MRI offers perfect visualisation of gastric balloons in obese patients. Gastric filling and emptying can be monitored in correlation to patient satiety sensation. MRI can visualize the gastric balloon with degree of filling and possible leakages. Cine mode sequences demonstrate gastric motility and gastric wall peristalsis. CONCLUSION: MR is a valuable imaging alternative for patients with intragastric balloons.